MEDICARE: LAVONA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548773211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONA LEWIS

Provider Business Mailing Address
First Line	:	4023 BENEVOLENT DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6167
Country	:	US
Telephone Number	:	702-472-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	702-472-1598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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Directions to “ LAVONA LEWIS ” Practice Location

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